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DIAGNOSA GIZI
TERM AND DEFINI TI O N DOMAIN INTAKE
DIAN HANDAYANI
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Nutrition Diagnostic Term Unused Increased energy expenditure Unused Inadequate energy intake Excessive energy intake
Predicted sub optimal energy Intake Predicted excessive energy intake
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NI 1.3 Hypometabolism
Dihilangkan pada IDNT edisi 3 (2011) Rationate : It was determined that this is not a
nutrition diagnosis
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*If a synonym, or alternate word with the same meaning, for the term inadequate is helpful or needed, an approved alternate is the word suboptimal. ** Revisi Diagnosa pada edisi 2011
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Etiologi Kepercayaan/sikap yang salah terhadap makanan/gizi Pengetahuan yang kurang tentang makanan/gizi Kurangnya akses terhadap makanan yang sehat Kurangnya nilai/keinginan untuk mengubah kebiasaan Ketidakmampuan untuk membatasi/menolak makanan Kurangnya perencanaan terhadap pembelian dan penyiapan makanan, Kurangnya kontrol terhadap nafsu makan Pengobatan yang dapat meningkatkan nafsu makan, e.g., steroids, antidepressants
Psychological causes such as depression and disordered eating
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Clinical: Adanya tanda-tanda klinis defisiensi vitamin/mineral (e.g., hair loss, bleeding gums, pale nail beds, neurologic changes) Adanya tanda-tanda dehydrasi , e.g., mukosa membran kering, turgor kulit rendah Kehilangan integritas kulit, penyembuhan luka terhambat, or pressure ulcers Kehilangan masa otot/lemak subcutaneous Nausea, vomiting, diarrhea Dietary: Volume NE/NPE kurang dari kebutuhan Client History : Keadaan yang berhubungan dengan diagnosa/pengobatan, e.g., intestinal resection, Crohns disease, HIV/AIDS, burns, pre-term birth, malnutrition Kesalahan posisi feeding tube or venous access Perubahan aktivitas fisik
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Biochemical : Peningkatan rasio BUN : creatinine ratio (protein) Hyperglycemia (carbohydrate) Hypercapnia Peningkatan enzim liver
Anthropometric: Peningkatan BB Clinical: Edema karena kelebihan pemberian cairan
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Less than optimal enteral nutrition / Makanan enteral yang kurang optimal (NI-2.5)**
Definisi Enteral infusion that provides either fewer or more calories and/or nutrients or is of the wrong composition or type, enteral nutrition that is not warranted because the patient/client is able to tolerate an enteral intake, or is unsafe because of the potential for sepsis or other complications. Etiologi Physiological causes, e.g., improvement in patient/client status, allowing return to total or partial oral diet; changes in the course of disease resulting in changes in nutrient requirements Product or knowledge deficit on the part of the caregiver or clinician End-of-life care if patient/client or family do not desire nutrition support
Less than optimal enteral nutrition / Makanan enteral yang kurang optimal (NI-2.5)**
Biochemical: Abnormal levels of markers specific for various nutrients, e.g., hyperphosphatemia in patient/client receiving feedings with a high phosphorus content, hypokalemia in patient/client receiving feedings with low potassium content Anthropometric: Weight gain in excess of lean tissue accretion Weight loss Clinical Edema with excess fl uid administration Loss of subcutaneous fat and muscle stores Resolving or improved GI function Conditions associated with a diagnosis or treatment, e.g., major elective surgery, trauma, burns, head and neck cancer, and critically ill patients, acute lung injury, acute respiratory distress syndrome, treatments/therapy requiring interruption of infusion, transfer of nutrition care to a new setting or level of care, end of life care.
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Less than optimal enteral nutrition / Makanan enteral yang kurang optimal (NI-2.5)**
Dietary: Documented intake from enteral or parenteral nutrients that is consistently more or less than recommended intake for carbohydrate, protein, and/or fat especially related to patient/clients ability to consume an oral diet that meets needs at this point in time Documented intake of other nutrients that is consistently more or less than recommended Nausea, vomiting, diarrhea, high gastric residual volume Formula composition or type that is inconsistent with evidence-based practice Client History History of enteral or parenteral nutrition intolerance Verbalizations or written responses that are inaccurate or incomplete
2.6)** Excessive parenteral nutrition infusion (NI-2.7)** Less than optimal parenteral nutrition (NI-2.8)** Limited food acceptance / keterbatasan penerimaan makanan (NI-2.9)**
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combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence.
Etiologi Physiological causes, e.g., increased fluid needs due to climate/temperature change; increased exercise or conditions leading to increased fluid losses; fever causing increased insensible losses, decreased thirst sensation, use of drugs that reduce thirst Lack of access to fluid, e.g., economic constraints, cultural or religious practices, unable to access fluid independently such as elderly or children Food- and nutrition-related knowledge deficit Psychological causes, e.g., depression or disordered eating; dementia resulting in decreased recognition of thirst
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Dietary: Insufficient intake of fluid compared to requirements (e.g., per body surface area) Thirst Difficulty swallowing Client History Conditions associated with a diagnosis or treatment, e.g., Alzheimers disease or other dementia resulting in decreased recognition of thirst, diarrhea Use of drugs that reduce thirst
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SUBOPTIMAL* BIOACTIVE SUBSTANCE INTAKE / Intake komponen bioaktif tidak optimal (NI-4.1)**
Definisi Lower intake of bioactive substances compared to established reference standards or recommendations based on physiological needs. Note: Bioactive Substances are not included as part of the Dietary Reference Intakes, and therefore there are no established minimum requirements or tolerable upper limits. However, RDs can assess whether estimated intakes are adequate or excessive using the patient/client goal or nutrition prescription for comparison. Working definition of bioactive substancesphysiologically active components of foods that may offer health benefits beyond traditional macro- or micro-nutrient requirements. There is not scientific consensus about a definition for bioactive substances/components. Etiologi Food- and nutrition-related knowledge deficit Limited access to a food that contains the substance Altered GI function, e.g., pain or discomfort
SUBOPTIMAL* BIOACTIVE SUBSTANCE INTAKE / Intake komponen bioaktif tidak optimal (NI-4.1)**
Dietary: Low intake of plant foods containing: Soluble fiber, e.g., psyllium ( total and LDL cholesterol) Soy protein ( total and LDL cholesterol) -glucan, e.g., whole oat products ( total and LDL cholesterol) Plant sterol and stanol esters, e.g., fortified margarines ( total and LDL cholesterol) Other substances (for which scientific evidence exists and a recommended intake level has been established)
Client History Conditions associated with a diagnosis or treatment, e.g., cardiovascular disease, elevated cholesterol
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Etiologi Harmful beliefs/attitudes about food, nutrition, and nutrition-related topics Food- and nutrition-related knowledge deficit Lack of value for behaviour change, competing values Alcohol addiction
Sign/symptoms Biochemical Data, Medical Elevated aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), carbohydrate-defi cient transferrin, mean corpuscular volume, blood alcohol levels
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INCREASED NUTRIENT NEEDS (SPECIFY) / Peningkatan kebutuhan zat gizi tertentu (NI-5.1)
Definisi Increased need for a specific nutrient compared to established reference standards or recommendations based on physiological needs. Etiologi Altered absorption or metabolism of nutrient, e.g., from medications Compromise of organs related to GI function, e.g., pancreas, liver Decreased functional length of intestine, e.g., short-bowel syndrome Decreased or compromised function of intestine, e.g., celiac disease, Crohns disease Increased demand for nutrient, e.g., accelerated growth, wound healing, chronic infection
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INCREASED NUTRIENT NEEDS (SPECIFY) / Peningkatan kebutuhan zat gizi tertentu (NI-5.1)
Biochemical Data Decreased total cholesterol < 160 mg/dL, albumin, prealbumin, Creactive protein, indicating increased stress and increased metabolic needs Electrolyte/mineral (e.g., potassium, magnesium, phosphorus) abnormalities Urinary or fecal losses of specifi c or related nutrient (e.g., fecal fat, d-xylose test) Vitamin and/or mineral defi ciency Anthropometric: Growth failure, based on growth standards and fetal growth failure Unintentional weight loss of 5% in 1 month or 10% in 6 months Loss of muscle mass, subcutaneous fat Underweight (BMI < 18.5) Low percent body fat and muscle mass
INCREASED NUTRIENT NEEDS (SPECIFY) / Peningkatan kebutuhan zat gizi tertentu (NI-5.1)
Physical Examination Findings Clinical evidence of vitamin/mineral deficiency (e.g., hair loss, bleeding gums, pale nail beds) Loss of skin integrity, delayed wound healing, or pressure ulcers Dietary: Inadequate intake of foods/supplement containing needed nutrient as compared to estimated requirements Intake of foods that do not contain sufficient quantities of available nutrient (e.g., over processed, overcooked, or stored improperly) Food- and nutrition-related knowledge deficit (e.g., lack of information, incorrect information or noncompliance with intake of needed nutrient)
Client History Conditions associated with a diagnosis or treatment, e.g., intestinal resection, Crohns disease, HIV/AIDS, burns, pre-term birth, malnutrition Medications affecting absorption or metabolism of needed nutrient Athletes or active individuals engaged in intense physical activity
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DECREASED NUTRIENT NEEDS (SPECIFY) / Penurunan Kebutuhan Zat Gizi tertentu (NI-5.4)
Definisi Decreased need for a specific nutrient compared to established reference standards or recommendations based on physiological needs. Etiologi Renal dysfunction Liver dysfunction Altered cholesterol metabolism/regulation Heart failure Food intolerances, e.g., irritable bowel syndrome
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DECREASED NUTRIENT NEEDS (SPECIFY) / Penurunan Kebutuhan Zat Gizi tertentu (NI-5.4)
Biochemical Data, Medical Total cholesterol > 200 mg/dL (5.2 mmol/L), LDL cholesterol > 100 mg/dL (2.59 mmol/L), HDL cholesterol < 40 mg/dL (1.036 mmol/L), triglycerides > 150 mg/dL (1.695 mmol/L) Phosphorus > 5.5 mg/dL (1.78 mmol/L) Glomerular fi ltration rate (GFR) < 90 mL/min/1.73 m2 Elevated BUN, creatinine, potassium Liver function tests indicating severe liver disease Anthropometric: Interdialytic weight gain greater than expected
DECREASED NUTRIENT NEEDS (SPECIFY) / Penurunan Kebutuhan Zat Gizi tertentu (NI-5.4)
Clinical: Edema/fluid retention Dietary: Intake higher than recommended for fat, phosphorus, sodium, protein, fi ber Client History Conditions associated with a diagnosis or treatment that require a specific type and/or amount of nutrient, e.g., cardiovascular disease (fat), early renal disease (protein, phos), ESRD (phos, sodium, potassium, fl uid), advanced liver disease (protein), heart failure (sodium, fl uid), irritable bowel disease/Crohns fl are up (fi ber) Diagnosis of hypertension, confusion related to liver disease
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NI 5.6.2 NI 5.6.3
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INADEQUATE PROTEIN INTAKE / Intake protein tidak adekuat (NI-5.7.1) Clinic: Edema, failure to thrive (infants/children), poor musculature, dull skin, thin and fragile hair Food/Nutrition History Reports or observation of: Insuffi cient intake of protein to meet requirements Cultural or religious practices that limit protein intake Economic constraints that limit food availability Prolonged adherence to a verylow-protein weight-loss diet Client History Conditions associated with a diagnosis or treatment, e.g., severe protein malabsorption such as bowel resection
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INAPPROPRIATE INTAKE OF PROTEIN OR AMINO ACIDS (SPECIFY) / Ketidaksesuaian intake protein atau asam amino tertentu (NI-5.7.3)**
Definisi Intake of a amount of a specific type of protein or amino acids compared to established reference standards or recommendations based on physiological needs. Etiologi Liver dysfunction, Renal dysfunction, Metabolic abnormality Harmful beliefs/attitudes about food, nutrition, and nutrition-related topics Misused specialized protein products Food faddism Inborn errors of metabolism
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INAPPROPRIATE INTAKE OF PROTEIN OR AMINO ACIDS (SPECIFY) / Ketidaksesuaian intake protein atau asam amino tertentu (NI-5.7.3)**
Etiologi (lanjutan) Celiac disease, dermatitis herpetiformis Cultural or religious practices that affect the ability to regulate types of protein or amino acids consume Food- and nutrition-related knowledge deficit concerning an appropriate amount of a specific types of proteins or amino acids Food and nutrition compliance limitations, e.g., lack of willingness or failure to modify protein or amino acid intake in response to recommendations from a dietitian, physician, or caregiver Clinical: Physical or neurological changes (inborn errors of metabolism) Diarrhea in response to certain types of carbohydrates Abdominal pain, distention, constipation, reflux, GERD
INAPPROPRIATE INTAKE OF PROTEIN OR AMINO ACIDS (SPECIFY) / Ketidaksesuaian intake protein atau asam amino tertentu (NI-5.7.3)**
Biochemical Data, Medical Altered laboratory values, e.g., BUN, glomerular filtration rate (altered renal status) Elevated specifi c amino acids (inborn errors of metabolism) Elevated homocysteine or ammonia Positive autoantibody levels (Anti-Ttg antibodies, EmA IgA Tissue Transglutaminase (tTG) and IgA Endomysial Antibodies (EMA)) Positive small bowel biopsy for celiac disease Anthropometric: Weight loss, inability to gain weight, delayed growth
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INAPPROPRIATE INTAKE OF PROTEIN OR AMINO ACIDS (SPECIFY) / Ketidaksesuaian intake protein atau asam amino tertentu (NI-5.7.3)**
Food/Nutrition History Reports or observation of: Estimated protein or amino acid intake higher than recommended, e.g., early renal disease, advanced liver disease, inborn error of metabolism, celiac disease Estimated intake of certain types of proteins or amino acids higher than recommended for prescribed parenteral and enteral nutrition therapy Inappropriate amino acid or protein supplementation, as for athletes Higher than recommended amino acid intake, e.g., excess phenylalanine intake Client History Conditions associated with a diagnosis or treatment of illness that requires EN/PN therapy, celiac disease, dermatitis herpetiformis, allergies, inborn errors of metabolism History of inborn error of metabolism Uremia, azotemia (renal patients) Limited knowledge of protein or amino acid Composition of foods or of protein or amino acid metabolism Chronic use of medications contain proteins not recommended
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INAPPROPRIATE INTAKE OF TYPES OF CARBOHYDRATES (SPECIFY) / Ketidaksesuaian intake jenis karbohidrat tertentu (NI-5.8.3)
Definisi Intake of an amount of a specific the type or amount of carbohydrate that is more or less than the established reference standards or recommendations based on physiological needs. Note: Types of carbohydrate can refer generally to sugars, starch and fiber or specific carbohydrates (e.g., sucrose, fructose, lactose). Intolerance to the protein component of grains (e.g., gluten) should be documented using the Inappropriate intake of proteins or amino acids (NI-5.7.3) reference sheet.
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INAPPROPRIATE INTAKE OF TYPES OF CARBOHYDRATES (SPECIFY) / Ketidaksesuaian intake jenis karbohidrat tertentu (NI5.8.3)
Etiologi Physiological causes requiring careful use of modified carbohydrate, e.g., diabetes mellitus, metabolic syndrome, hypoglycemia, celiac disease, allergies, intolerance, inborn errors of carbohydrate metabolism obesity. Note. Although research does not support restriction of individual types of carbohydrate for glycemic control, dietetics practitioners may determine that restriction is warranted in unique patient/client situations for glycemic control and/or for other reasons, such as, promotion of healthful eating. Cultural or religious practices that affect the ability to regulate types of carbohydrate consumed Food- and nutrition-related knowledge defi cit, e.g., inability to access suffi cient information concerning more appropriate carbohydrate types and/or amounts Food and nutrition compliance limitations, e.g., lack of willingness or failure to modify carbohydrate intake in response to recommendations from a dietitian, physician, or caregiver Psychological causes, e.g., depression or disordered eating
INAPPROPRIATE INTAKE OF TYPES OF CARBOHYDRATES (SPECIFY) / Ketidaksesuaian intake jenis karbohidrat tertentu (NI5.8.3)
Biochemical Data Hypoglycemia or hyperglycemia Dietary: Diarrhea in response to high intake of refi ned carbohydrates Economic constraints that limit availability of appropriate foods Carbohydrate intake that is a different from recommended types or exceeds amount recommended for that specific type of carbohydrate Allergic reactions or intolerance to certain carbohydrate foods or food groups Limited knowledge of carbohydrate composition of foods or of carbohydrate metabolism
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Dietary: Fiber intake higher than tolerated or generally recommended for current medical condition Client History Conditions associated with a diagnosis or treatment, e.g., ulcer disease, irritable bowel syndrome, infl ammatory bowel disease, short-bowel syndrome, diverticulitis, obstructive constipation, prolapsing hemorrhoids, gastrointestinal stricture, eating disorders, or mental illness with obsessive-compulsive tendencies Nausea, vomiting, excessive fl atulence, diarrhea, abdominal cramping, high stool volume or frequency that causes discomfort to the individual; obstruction; phytobezoar
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containing vitamins as compared to estimated requirements, including fortifi ed cereals, meal replacements, vitamin-mineral supplements, other dietary supplements (e.g., fi sh liver oils or capsules), tube feeding, and/or parenteral solutions Intake > Tolerable Upper Limit (UL) for vitamin A (as retinol ester, not as carotene) is 600 g/d for infants and toddlers; 900 g/d for children 4-8 y, 1700 g/d for children 9-13 y, 2800 for children 14-18 y, and 3000 g/d for adults Intake more than UL for vitamin D is 25 g/d for infants and 50 g/d for children and adults Niacin: clinical, high-dose niacinamide (NA), 1-2 g, three times per day, can have side effects Client History Conditions associated with a diagnosis or treatment, e.g., chronic liver or kidney diseases, heart failure, cancer
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INADEQUATE* MINERAL INTAKE (SPECIFY) / Intake mineral tertentu tidak adekuat (NI-5.10.1)
Definisi Lower intake of one or more minerals compared to established reference standards or recommendations based on physiological needs. Note:Whenever possible, nutrient intake data should be considered in combination with clinical, biochemical, anthropometric information, medical diagnosis, clinical status, and/or other factors as well as diet to provide a valid assessment of nutritional status based on a totality of the evidence. Etiologi Physiological causes, e.g., increased nutrient needs due to prolonged catabolic illness, malabsorption, hyperexcretion, nutrient/drug and nutrient/nutrient interaction, growth and maturation Lack of access to food, e.g., economic constraints, cultural or religious practices, restricting food given to elderly and/or children
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INADEQUATE* MINERAL INTAKE (SPECIFY) / Intake mineral tertentu tidak adekuat (NI-5.10.1)
Etiologi (lanjutan) Food- and nutrition-related knowledge defi cit concerning food sources of minerals; misdiagnosis of lactose intolerance/lactase defi ciency; perception of confl icting nutrition messages from health professionals; inappropriate reliance on supplements Psychological causes, e.g., depression or eating disorders Environmental causes, e.g., inadequately tested nutrient bioavailability of fortifi ed foods, beverages, and supplements; inappropriate marketing of fortifi ed foods/beverages/supplements as a substitute for natural food source of nutrient(s) Decreased ability to consume sufficient amount of a mineral (s)
INADEQUATE* MINERAL INTAKE (SPECIFY) / Intake mineral tertentu tidak adekuat (NI-5.10.1)
Biochemical Data Calcium: bone mineral content (BMC) below the young adult mean. Hypocalciuria, serum 25(OH)D < 32 ng/mL Phosphorus < 2.6 mg/dL (0.84 mmol/L) Magnesium <1.8 mg/dL (0.7 mmol/L) Iron: hemoglobin < 13 g/L (2 mmol/L) (males); < 12 g/L (1.86 mmol/L) (females) Iodine: urinary excretion < 100 g/L (788 nmol/L) Copper, serum copper < 64 g/dL (10 mol/L) Anthropometric: Height loss Clinical: Calcium: diminished bone mineral density, hypertension, obesity
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INADEQUATE* MINERAL INTAKE (SPECIFY) / Intake mineral tertentu tidak adekuat (NI-5.10.1)
Dietary Insufficient mineral intake from diet compared to recommended intake: Food avoidance and/or elimination of whole food group(s) from diet Lack of interest in food Inappropriate food choices and/or chronic dieting behavior Vitamin/mineral defi ciency Client History Conditions associated with a diagnosis or treatment, e.g., malabsorption as a result of celiac disease, short bowel syndrome, infl ammatory bowel disease, or post-menopausal women without estrogen supplementation and increased calcium need Polycystic ovary syndrome, premenstrual syndrome, kidney stones, colon polyps Other signifi cant medical diagnoses and therapies Geographic latitude and history of Ultraviolet-B exposure/use of sunscreen Change in living environment/independence
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Prediksi intake zat gizi tertentu tidak optimal (NI5.11.1)** Predicted excessive nutrient intake (specify) / Prediksi kelebihan intake zat gizi tertentu (NI5.11.1)**
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Discussion
referensi
Referensi American Dietetic Association (2011). International Dietetics and Nutrition Terminology (IDNT) Reference Manual - Standardize Languaged for The Nutritional care Process. Chicago, IL 60606-6995, American Dietetic Association.
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